Abstract
Small rural hospitals face considerable financial and personnel resource shortages which hinder their efforts to implement complex health information technology (HIT) systems. A survey on the use of HIT was completed by 85% of Iowa’s 82 Critical Access Hospitals (CAH). Analyses indicate that low IT staffing in CAHs is a barrier to implementing HIT solutions. CAHs with fewer staff tend to employ alternative business strategies. There is a clear relationship between having IT staff at a CAH and the types of technologies used. Many CAHs report having difficulty expanding upon HIT functionalities due to the challenges of finding IT staff with healthcare expertise. Most CAHs are in the transition point of planning for or beginning implementation of complex clinical information systems. Strategies for addressing these challenges will need to evolve as the HIT investments by rural hospitals race to keep pace with the goals for the nation.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
American Hospital Association. Continued progress—hospital use of information technology. http://www.aha.org/aha/content/2007/pdf/070227-continuedprogress.pdf. Accessed October 25, 2008.
Li, P., Bahensky, J. A., Jaana, M., and Ward, M. M., Role of multihospital system membership in electronic medical record adoption. Health Care Manage. Rev. 33 (2)1–9, 2008.
American Hospital Association, Forward momentum: hospital use of information technology. American Hospital Association, Chicago, 2005.
Jaana, M., Ward, M. M., Pare, G., and Wakefield, D. S., Clinical information technology in hospitals: a comparison between the state of Iowa and two provinces in Canada. Int. J. Med. Inform. 74(9):719–731, 2005.
Kimberly, J. R., and Evanisko, M. J., Organizational innovation: the influence of individual, organizational, and contextual factors on hospital adoption of technological and administrative innovations. Acad. Manage. J. 24(4):689–713, 1981.
Wang, B. B., Wan, T. T., Burke, D. E., Bazzoli, G. J., and Lin, B. Y., Factors influencing health information system adoption in American hospitals. Health Care Manage. Rev. 30(1):44–51, 2005.
Bahensky, J. A., Jaana, M., and Ward, M. M., Healthcare information technology in rural America: electronic medical record adoption status in meeting the national agenda. J. Rural Health. 24(2):101–105, 2008.
Medicare Payment Advisory Commission, Report to the Congress: issues in a modernized Medicare program. MedPAC, Washington (DC), 2005.
Medicare Payment Advisory Commission, Report to the Congress: Medicare in rural America. MedPAC, Washington (DC), 2001.
Li, P., Schneider, J. S., and Ward, M. M. Effects of critical access hospital conversion on the financial performance of rural hospitals, Inquiry, 2009, in press.
Li, P., Schneider, J. S., and Ward, M. M., The effect of critical access hospital conversion on patient safety. Health Serv. Res. 42:2089–2108, 2007.
Bahensky, J. A., Frieden, R., Moreau, B., and Ward, M. M., Critical access hospital informatics. How two rural Iowa hospitals overcame challenges to achieve IT excellence. J. Healthc. Inf. Manag. 22(2):16–22, 2008.
Ward, M. M., Jaana, M., Bahensky, J. A., Vartak, S., and Wakefield, D. S., Clinical information systems availability and use in urban and rural hospitals. J. Med. Syst. 30:429–438, 2006.
Flex Monitoring Team. The current status of health information technology use in CAHs. Flex Monitoring Team Briefing Paper No. 11; May 2006. http://www.flexmonitoring.org/documents/BriefingPaper11_HIT.pdf. Accessed October 25, 2008.
Houser, S. H., and Johnson, L. A., Perceptions regarding electronic health record implementation among health information management professionals in Alabama: a statewide survey and analysis. Perspectives in Health Information Management. 5:6, 2008.
Iowa Hospital Association. Profiles; Section VI: Hospital and Health System Specific Data. 2005, http://www.ihaonline.org/publications/profileserv/profileserv.shtml. Accessed October 25, 2008.
Biddle, B. Assessing high-speed internet access in the state of Iowa: Fifth Assessment. A Report of the Iowa Utilities Board. May 2006.
HIMSS. 17th Annual 2006 HIMSS Leadership Survey. Health Information Management Systems Society. February 13 2006. http://www.himss.org/2006Survey/healthcareCIO_home.asp. Accessed October 25, 2008.
Jha, A. K., Ferris, T. G., Donelan, K., DesRoches, C., Shields, A., Rosenbaum, S., and Blumenthal, D., How common are electronic health records in the United States? A summary of the evidence. Health Aff. 25:w496–w507, 2006.
Garets, D., and Davis, M. Electronic medical records vs. electronic health records: Yes, there is a difference. HIMSS Analytics. January 26, 2006. http://www.himssanalytics.org/docs/WP_EMR_EHR.pdf. Accessed October 25, 2008.
United States Department of Health and Human Services. Office of the National Coordinator for Health Information Technology (ONC): Goals of strategic framework. December 10, 2004. http://www.hhs.gov/healthit/goals/html. Accessed November 6, 2008.
Robert Half Technology. Competing for top IT talent in a tight market. Infrastructure Insite. April/May/June: 20–23, 2007.
Lee, K. S. Business acumen: the new must-have skill. Infrastructure Insite. April/May/June: 25–27, 2007.
Lanzalotta, J. High-impact tech talent in high demand. ComputerWorld. March 1, 2007. http://www.computerworld.com/action/article.do?command=printArticleBasic&articleId=284494. Accessed October 25, 2008.
Fenton, S. H., Amatayakul, M., and Work, M., The HIM impact on EHRs: newly released study links HIM professionals and successful EHR implementations. J. AHIMA. 77(9):36–40, 2006.
Acknowledgement
Support for this work was funded in part by the Agency for Healthcare Research and Quality through grant # HS015009.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bahensky, J.A., Ward, M.M., Nyarko, K. et al. HIT Implementation in Critical Access Hospitals: Extent of Implementation and Business Strategies Supporting IT Use. J Med Syst 35, 599–607 (2011). https://doi.org/10.1007/s10916-009-9397-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10916-009-9397-z